全膝关节置换术后小腿肌间静脉血栓临床研究

Muscular Calf Vein Thrombosis after Total Knee Arthroplasty

目的:探讨全膝关节置换(TKA)术后患者小腿肌间静脉血栓(MCVT)的临床特点,分析TKA术后MCVT发生的危险因素。方法:对298例因重度骨关节病而行TKA的患者进行回顾性研究,统计TKA术后MCVT的发病率,研究TKA术后MCVT患者的年龄和性别分布情况、临床表现以及MCVT患者的治疗措施和转归情况,分析TKA术后发生MCVT的危险因素。结果:TKA术后MCVT的发病率为21%,单膝TKA和双膝TKA(P>0.05)之间、男女之间(P>0.05)的发病率无显著性差异。MCVT的临床表现以肿胀(55.22%)和疼痛(44.78%)为主,Neuhof征(79.10%)和Homans征(62.69%)阳性率较高。MCVT发生后,加大抗凝药物的用量治疗,预后良好。TKA术后MCVT发生的独立危险因素是高龄、手术使用止血带时间长和术后D-dimer≥5 mg/L。结论:TKA术后MCVT的发生率高,应结合临床体征和彩色多普勒超声检查早期诊断,及时加大抗凝药物的剂量。对高龄、手术使用止血带时间长和术后D-dimer明显升高的患者,应特别注意MCVT的发生。

Objective To summarize the clinical characteristics of muscular calf vein thrombosis(MCVT) in patients after total knee replacement(TKA) and analyze the risk factors of MCVT.Methods The incidence rate,age and gender distribution,clinical symptoms and signs,treatment and prognosis of 298 MCVT patients after TKA were retrospectively studied and the risk factors of MCVT after TKA were analyzed.Results The incidence of MCVT in patients after TKA was 21%,and there were no significant differences between the unilateral and bilateral TKA(P>0.05),as well as males and females(P>0.05). The main clinical symptoms of MCVT were swelling(55.22%) and pain(44.78%),together with the high positive rate of Neuhof sign(79.10%) and Homans sign(62.69%). For MCVT patients,increased dosage of anticoagulant could achieve good prognosis. The independent risk factors of MCVT after TKA were advanced age,long-duration tourniquet application during TKA and postoperative D-dimer≥5 mg/L.Conclusion The incidence of MCVT is very high in patients after TKA. Clinical examination combined with color duplex ultrosonography should be conducted to achieve early diagnosis,so as to increase the dosage of anticoagulant in time. Special attention should be given to elderly patients, as well as those with long-duration tourniquet application during TKA and significantly increased D-dimer after TKA.